The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Thursday, September 10, 2009

Daughter claims stroke-victim father being systematically killed by British hospital

Recovery from stroke can often be quite good -- even for the elderly -- and the fact that the man can still talk and communicate would seem to be a positive indicator. The whole British system for dealing with the incapacitated elderly is just cost-saving with a flimsy humanitarian cloak on

The daughter of a stroke victim claims that her father is to be wrongly placed on an NHS scheme for the terminally ill which experts say is causing some patients to die too soon. Rosemary Munkenbeck says her father Eric Troake, who entered hospital after suffering a stroke, had fluid and drugs withdrawn and she claims doctors wanted to put him on morphine until he passed away under a scheme for dying patients called the Liverpool Care Pathway (LCP).

Mrs Munkenbeck, 56, from Bracknell, said her father, who previously said he wanted to live until he was 100, has now said he wants to die after being deprived of fluids for five days.

Along with her sister Jocelyn Troake, 60, who lived in Bermuda until recently moving to Frimley, Surrey, to care full time for her father and her mother Edna, 93, they are convinced their father is a victim of the system.

Last week The Daily Telegraph reported a warning from experts that some patients with terminal illnesses were being wrongly put on the NHS scheme and allowed to die prematurely if they ticked “the right boxes". The pathway scheme was developed to improve the care of patients in their dying hours and ensure that they were not being "overmedicalised". The scheme encourages doctors and other health care staff to consider removing medication, fluids and other treatments that no longer benefit the patient. It also recommends discussing the situation with relatives, and if possible, with the patient themselves.

Mrs Munkenbeck said that her father was taken off an intravenous drip last week but she argues that he has as much of a right to life as anyone else. Although a spokesman for Frimley Park Hospital in Surrey says Mr Troake is not on the scheme "at the moment", it is likely he will be offered a plan of care for dying patients.

"We believe that he has been forced down this route. By withdrawing fluids he is now very weak and there's no going back from it," she told The Daily Telegraph yesterday.

Previously she had called on him to be given the treatment to "see if he can survive." "Let his body do his own job with a little bit of help. If it's not possible we don't necessarily expect him to be put on a ventilator," she said. "We don't know that he will die. He might do, he might not, but we feel that's not the doctor's decision to do that."

Mr Troake, a former accountant and Second World War veteran, was admitted to the hospital in June after suffering a stroke. Although Mrs Munkenbeck admits her father is "confused", she argues that is because of the drugs the hospital have given him. When a patient is put on the pathway the medical team looks for signs that they are approaching their final hours, which can include loss of consciousness or difficulty swallowing medication.

But doctors last week warned semi-consciousness and confusion are a side effect of painkillers such as morphine if patients are also dehydrated.

"We've been arguing with them and they don't like it," Mrs Munkenbeck claims. "They say my sister and I are cruel and are trying to hold on to our father. But this man has a right to life. "I just want him protected. He's looking at us and talking to us. He's not suffering from a terminal illness, he just had a stroke. We just feel they decided from the beginning that he's 95 so they've written him off."

A spokesman for Frimley Park Hospital said: "Sometimes, actively treating a patient who is dying can unnecessarily prolong suffering. "The decision to withhold treatment which is prolonging suffering is only taken after careful consideration by a multidisciplinary team of clinicians, in consultation with the family and, when possible, the patient. Care of a patient who is dying would include the continued treatment of symptoms which may be causing them pain or distress.

"Looking after a patient who is dying may include care in accordance with the Liverpool Care Pathway. "The Liverpool Care Pathway allows patients to face dying with as little discomfort and as much dignity as possible while they are given appropriate individualised care."

Palliative care experts including Prof Peter Millard, Emeritus Professor of Geriatrics, University of London and Dr Peter Hargeaves, a consultant in Palliative Medicine, last week warned that the LCP can mask signs that a patient's condition is improving. “Forecasting death is an inexact science,” they wrote. Patients are being diagnosed as being close to death "without regard to the fact that the diagnosis could be wrong. “As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

The LCP has been gradually adopted nationwide and more than 300 hospitals, 130 hospitals and 560 care homes in England use the system. Marie Curie, the charity which drew up the pathway, has defended the scheme insisting that it is not about ticking boxes and that it has improved the end of life experience for thousands of people.

British doctor says NHS trust branded him a 'trouble-maker' when he spoke out about cost-cutting

A leading cancer consultant who repeatedly raised concerns about the health and safety of patients at a London hospital will claim today that he was victimised by managers and had his warnings ignored. Ramon Niekrash, 50, a consultant urologist at the Queen Elizabeth Hospital in south-east London, alleges that warnings he made in a series of letters about chronic cost-cutting led to him being branded a "trouble-maker" and excluded from the hospital last year.

In his whistleblowing employment case against the Queen Elizabeth Hospital NHS Trust, Mr Niekrash will tell a tribunal that the reduction of specialist nurses and closure of the specialist urology ward damaged the care of patients.

Mr Niekrash also questioned the hospital's ability to provide a safe service, and made further allegations of widespread bullying of other staff in the Surgical Directorate when the hospital tried to cut costs.

Queen Elizabeth, in Woolwich, reopened in 2002 after a £93m rebuilding scheme funded by a Private Finance Initiative (PFI), but declared itself technically insolvent in 2006 after auditors said it was heading for a deficit of £100m by 2008-09. This year it merged with two other hospitals to form the South London Healthcare NHS Trust.

Ahead of today's employment tribunal hearing in Croydon, Mr Niekrash told The Independent: "I would have been failing in my duty as a doctor if I had not brought the matters of patient care and safety to the attention of trust management. However, as a result of so doing I have suffered the consequences and been perceived as a difficult person and trouble-maker." He added: "I believe I have suffered the consequences of having raised those issues in a trust management system, which put cost savings above the issues of patient care. The issues I raised have still not been resolved and have manifested. I am saddened by the slur that this has caused on my reputation and the perception of me within the trust, which continue to have an impact upon me."

Mr Niekrash, head of urological cancer between January 2002 and November 2007 and president of the South-Eastern Urostomy Association, was responsible for identifying problems and suggesting improvements to the service. From 2005 he wrote letters to the trust's management laying out his concerns about the health and safety of patients. He claims the "vast majority" of these went unanswered, which led him to write further letters to "a wider consultant audience" to bring proper attention to his concerns.

His lawyer, Arpita Dutt, of employment law firm Russell Jones & Walker, said her client had been victimised for acting in the public interest. She said: "The NHS's stance on whistleblowing is clear, but if someone at such a senior level can be treated like this, what message does that send to other employees with concerns to raise? "The decision to exclude Mr Niekrash was high-handed and unjustified, and has had an ongoing adverse impact on his reputation, practice and his health. Like many similar whistleblowing claims, the focus of attention was on the messenger rather than the important and unambiguous message being conveyed."

A spokesman for the hospital said the trust would fight the case: "He [Mr Niekrash] makes a number of claims against the Queen Elizabeth Hospital... the trust denies all the claims and will contest them robustly." [Leftists are good at denial]

British Engineer Left Blind for Three Years Awaiting 20-Minute Operation

From the National Center for Public Policy Research's new book, "Shattered Lives: 100 Victims of Government Health Care", authored by Amy Ridenour and Ryan Balis:

According to Britain’s state-managed health service, cataract surgery is a “common” and “straightforward” operation that usually should last between 15 and 20 minutes. But such a quick turnaround would have been news to Richard Adams of London, who went blind in both eyes while waiting three years for cataract surgery.

The 85-year-old retired engineer and award-winning dancer began losing his vision in 2004. That year, doctors diagnosed Adams with cataracts, but an operation to remove them was not scheduled until March 2007. His excitement in 2007 at the prospect of getting his sight and livelihood back was short-lived because doctors cancelled the surgery. “I was over the moon when I found out I had an appointment in March [2007] but when it was cancelled I just went downhill,” Adams said at the time.

Stuck in a wheelchair and suffering from asthma as well as kidney stones (also left untreated by the NHS, he said), Adams had difficulty performing everyday tasks. “I never cook anything,” Adams explained then. “It always has to be cold things like sandwiches or salad. I can’t go to the shops because I can’t see where I’m going.”

In despair, Adams said his life was “being wasted”: “I have all these ideas in my head but I can’t see to write and I can’t see to draw. All I can do is sit in my house and listen to the TV. I can’t see it and I have to turn up the volume because I can’t hear well.”

Spokesman Mark Purcell of Ealing Hospital, one of several hospitals that refused Adams treatment for his eyes, offered no sympathy. “If [Adams] has a complaint about the standard of care he has received he should write to the chief executive of the Ealing Hospital Trust.” (Whether this bureaucratic solution, which asked a blind man to write, was intentionally or inadvertently cruel is unknown.)

Adams was scheduled to receive treatment in late May, but this was little consolation for him. “I’ve been waiting for three years but they don’t seem to care. I think they’re just waiting for me to die or something,” Adams complained.

Finally, after Adams’ plight received attention from the British press, doctors removed the cataracts in one of his eyes in June 2007. “He was really pleased with the result of the operation,” said Roger Woolsey, a family friend. “When I went to visit him he would raise the eye-patch and say: I really can see again.”

Tragically, four days after the procedure that restored his sight, Adams died. He had a heart attack after developing blood poisoning in the hospital.

New immigration regulations forcing top US surgeon out -- but publicity seems to have produced some backpedalling. Mackay hospital has had big problems. They badly need all the expertise they can get. A system that takes expertise away from them is insane.

A WORLD-famous US surgeon pulled out of retirement to fill in at a regional hospital for 12 years has been forced to sell his house and abandon Australia in an "appalling" visa bungle. Dr Frank Trost, 77, a globally recognised orthopedic surgeon, has been locked in a bitter six-month wrangle over his visa status amid new restrictions on foreign-trained doctors. Yet, despite the dire shortage of doctors in regional hospitals, Queensland Health and the Immigration Department have refused to budge.

"I feel badly used," Dr Trost said yesterday. "If I'd not gone back to work, I'd be happily retired and still living the dream. We don't want to go. This is our home. But we have no choice."

Fellow surgeons, locals and patients are outraged at the "appalling" treatment of the specialist, who will be forced to return to the US. "He has been used and abused," said Dr Don Pitchford, chairman of the International Medical Graduates Committee. "They took their pound of flesh, now they've kicked him in the guts, tossed him on the scrapheap, and told him, 'You're too old, get out of the country'. It is a disgrace."

Dr Pitchford, director of orthopedics at Gold Coast Hospital, said one solution would be to give Dr Trost an honorary medical fellowship, or to simply give him back his original retirement visa. "If this is the sort of citizen we are kicking out, we should all hang our heads in shame," he said.

Dr Trost and his wife Nancy came to Australia from the US on a retirement visa in 1996 to live by the beach in Mackay. But once word got out of his international stature as a surgeon and expert in amputations, he was asked to join the understaffed Mackay Base Hospital. Then at 65, he did so, sharing his skills and knowledge, administrating his department for more than a decade after stopping surgery because of age restrictions. Dr Trost had the added comfort of a personal letter from the then federal immigration minister reassuring him he would be allowed to go back on to his retirement visa once he finished work.

"I didn't come here to get a job," said Dr Trost, who is now on a temporary 457 work visa. "But when duty called, I felt I had a responsibility to help my fellow man. It has been nerve-racking, very stressful and strenuous, being in limbo for so long." Dr Frost said he and his wife could not get permanent residency because of new rules against foreign-trained doctors over the age of 45.

Two weeks ago, the couple sold their beachside home and are "mentally packing" to leave to start a new life near San Diego, California. He is today in his last week of work at Mackay Base Hospital after resigning in protest over a series of conditions imposed on his work. One included sitting a multiple-choice Australian Medical Council exam this month before spending two years in the wards as an intern, he said.

Mackay Mayor Col Meng said he sympathised with the highly respected medico. "He's 77 years old, they've been using him, but it shows you've got to play by the rules," he said.

An Immigration Department spokesman confirmed the couple's status was in limbo. "He's not being kicked out. No decision has been made," the spokesman said. "We've been in touch with him, we're still processing it." Mackay Health District chief executive Kerry McGovern said Queensland Health had no control over visa conditions. "The responsibility for meeting those requirements rests with the doctor, not the employer," he said. [They really sound as if they care, don't they? They are one of Australia's most malign bureaucracies]

Barack Obama's battle to save his blurry vision of US health care reform

Democrats are mounting a last-ditch attempt to broker a bipartisan deal to reform America's health care system as Barack Obama prepares to address Congress. The speech to Congress is seen as so important that it could make or break his presidency. With Mr Obama's poll numbers slipping and public support for his health care overhaul eroding almost by the day, Senator Max Baucus, a fellow Democrat, drew up a compromise plan designed to appeal to centrists across the political divide.

Republicans have vigorously opposed a mooted extra tax burden on highers earners to pay for medical insurance for the poor. Under the new plan, non-profit co-operatives would be set up to compete with private health insurance companies. This would replace the idea of introducing a so-called "public option" of government-run insurance, which is favoured by liberals.

The Baucus plan would cost about $900 billion (£550 billion) over 10 years - $100 billion less that the $1 trillion price tag on a previous House of Representatives proposal. This would partly be achieved by raising $180 billion from taxing insurance companies that offer the most expensive packages.

All insurance companies would be charged an additional fee according to their market share. This is intended to help pay for the reform and exact a price from insurers, who stand to gain 46 million new customers - those who are currently uninsured. Mr Baucus said that the plan was not a final one and that he hoped a deal might be reached before Mr Obama speaks to a joint session of Congress on Wednesday.

Mr Obama is following in the footsteps of President Bill Clinton, who addressed Congress in 1993 with a plea for health care reform to be passed. Although public support for his plan increased, he was ultimately unsuccessful.

Acutely aware of the mistakes Mr Clinton made, Mr Obama decided to let Congress draft legislation rather than drawing up a White House bill, as Mr Clinton did. But that has led to a sense of drift with voters not sure exactly what Mr Obama supports. Mr Obama's aides have indicated that the "public option" idea will be dropped after it became clear it was too politically contentious among the public, Republicans and conservative Democrats.

Mr Baucus's Senate Finance Committee has so far been unable to agree on legislation and he is attempting to woo three Republican senators who might be convinced. If a deal is not reached, the Senate Finance Committee could be bypassed.

Senator Chuck Grassley, one of the Republicans being courted, told CNN that the Obama administration had been "all over the ballpark" on the health issue before Congress's summer recess and that he still wanted to find a bipartisan consensus. Asked about the prospects of the Baucus plan being agreed, he replied: "We won't know until we meet. The good and the bad of the president speaking this week is we've had to speed up the work of our group to have something better ... and that's bad because we probably should have taken a little more time." He added that he was concerned that any fee charged to insurance companies would end up getting passed on to other customers but was in favour of non-profit health care co-operatives.

Senator Max Baucus yesterday pushed a new health care plan including an insurance industry fee to help pay for covering the uninsured, and President Obama said insurance companies must share accountability for the troubled system.

In a Labor Day speech in Cincinnati yesterday, Obama said a health insurance system should work as well for all Americans as it does for the insurance industry. “They should be free to make a profit. But they also have to be fair. They also have to be accountable,’’ the president said. “That’s what we’re talking about - security and stability for folks who have health insurance, help for those who don’t, coverage they need at a price they can afford, finally bringing costs under control - that’s the reform that’s needed.’’ [Sounds like it's a magic wand that's needed]

Baucus is part of a six-member bipartisan group trying to craft a bill satisfactory to both parties. The group is set to meet today as Congress returns from its August recess. The plan proposed by Baucus is designed to create competition in the insurance market. Insurers would be required to release the administrative costs included in premiums, as well as profits, so customers would know whether they were getting a fair deal at a good price.

It’s unclear whether the plan would win support of two key Republicans in the group: Chuck Grassley of Iowa and Mike Enzi of Wyoming. The Baucus proposal reflects many of their priorities, chief among them the decision not to include a government-run plan to compete with private insurers.

Democratic sources close to the negotiations, who were not authorized to be quoted by name, disclosed the fee and other details of the Baucus proposal. One source said the proposal included suggestions from all six members.

The fee is only a piece of a Baucus proposal that would establish a new way to purchase coverage for Americans who have trouble getting and keeping health insurance. Americans could keep their own doctors.

White House press secretary Robert Gibbs, accompanying Obama in Ohio yesterday, told reporters the administration would be pleased if the Finance Committee would “pull together the strands of many different pieces of legislation to improve health care for all Americans.’’

Under the Baucus plan, health insurance exchanges, with information on different plans and prices, would allow small groups and individuals to buy policies at lower rates. Medicaid would be expanded to cover more low-income people. Nonprofit cooperatives would be established as an alternative to for-profit insurance companies, giving consumers more choices. Tax credits would allow low- and middle-income Americans to buy private coverage. The package would cost under $900 billion over 10 years.

One Democratic source said the proposal was not final. Finance Committee members were encouraged to suggest modifications, although Baucus advised senators that any proposals that would increase costs should include provisions to offset them. If insurance companies passed the new fee along to customers, they would run the risk of losing out in a newly competitive environment, a source said.

Obama is getting no shortage of advice on what to say in his health care speech to Congress, and much of it conflicts. Liberals want him to issue a call to action - clear and bold. Conservatives hope he’ll back away from his push for sweeping changes this year and break health care legislation into smaller pieces.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here